Drug IndexUplizna (Inebilizumab)



Billing

Code: J1823

Description: Inj. inebilizumab-cdon, 1 mg

Unit: 1 MG

Payment: $473.513

Pay quarter: Q2 2024


Covered in Part D: No


Drug Cost

Calculate drug cost and reimbursement


Total WAC:

N/A

Total Reimbursement:

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(ASP: N/A, Margin: N/A)

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# Units to bill:

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Billable NDCs

72677-0551-01

UPLIZNA (Viela Bio, Inc.)

3 VIAL, SINGLE-DOSE in 1 CARTON (72677-551-01) / 10 mL in 1 VIAL, SINGLE-DOSE (72677-551-03)


75987-0150-03

UPLIZNA (Horizon Therapeutics USA, Inc.)

3 VIAL, SINGLE-DOSE in 1 CARTON (75987-150-03) / 10 mL in 1 VIAL, SINGLE-DOSE (75987-150-01)



Prior Authorization


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